Provider Demographics
NPI:1609815257
Name:WATTS, THOMAS J (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:WATTS
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Gender:M
Credentials:DO
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Mailing Address - Street 1:100 ENGLISH OAK RD
Mailing Address - Street 2:C/O UPSTATE EMERGENCY PHYSICIANS, LLC
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5103
Mailing Address - Country:US
Mailing Address - Phone:864-297-9483
Mailing Address - Fax:864-297-6574
Practice Address - Street 1:1650 SKYLYN DR
Practice Address - Street 2:MARY BLACK MEMORIAL HOSPITAL - EMERGENCY DEPT.
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1047
Practice Address - Country:US
Practice Address - Phone:864-573-3885
Practice Address - Fax:864-573-3299
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-13
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Provider Licenses
StateLicense IDTaxonomies
SC00567207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT00781Medicaid
G21009Medicare UPIN